Exactly how it will work is yet to be determined.
From 1 July 2027, a $5000 threshold will apply to veterans’ spending on allied health care each fiscal year to limit “unnecessary over servicing” – but exactly what that means for GPs is still unclear.
The Department of Veterans Affairs’ (DVA) rationale said that only about one in 10 veteran cardholders spend more than $5000 per year on allied health services.
However, the DVA said it would continue to fund care exceeding $5000 where there was a demonstrated and valid clinical need.
Appointments with Open Arms, a veterans’ psychology and family counselling service, would not count towards the $5000 annual threshold.
Veterans would no longer require a new referral after 12 allied health sessions, scrapping the current 12-session or 12-month treatment cycle.
The changes address provider exploitation of some veterans, the administrative burden imposed by treatment cycle restrictions, and recommendations from the Royal Commission into Defence and Veteran Suicide, the DVA said.
The announcement, first made in the May budget, said it would save the budget about $748 million over three years, with just over $340 million saved each year thereafter.
In turn, the government said it would invest $169.7 million to increase fees for allied health professionals – the biggest investment in 20 years.
“DVA is working to ensure the process is simple and how approval for additional limits will be made quickly,” the announcement read.
In an ABC Radio National interview today, health minister Mark Butler said the decision had been carefully considered by minister for veterans affairs Matt Keogh.
“[The veterans’ portfolios have] been going through the really challenging work of implementing the Royal Commission into veterans’ suicide and that involved frankly quite a root and branch look at the way in which we were delivering the support that our veterans deserve,” Mr Butler said.
In a senate meeting on Wednesday, independent senator for Tasmania Jacqui Lambie – a veteran herself – spoke of her recent surgery for a vaginal prolapse, directly linked to her service-related back injury.
Ms Lambie said she ended up paying $7,000 out of pocket for the emergency operation.
Her response to the $5,000 cap was scathing, accusing the government of “callous disregard for veterans’ health and wellbeing” and urging for the cap to be scrapped.
It’s since drawn much criticism from some veterans as “another betrayal”, but veteran and RACGP rural chair Associate Professor Michael Clements told The Medical Republic the proposed policy was a “very reasonable response” to ensuring financial responsibility for taxpayer money and to protecting veterans.
“I’ve witnessed many of my veterans being preyed upon by providers promoting [themselves using] push services, so contacting them through social media to access their allied health service, even when the need wasn’t clear to either the veteran or the treating GP,” he said.
Professor Clements said he had witnessed firsthand veterans receiving messages from companies promoting cannabis and erectile dysfunction products they weren’t seeking.
“DVA is working very hard to work with GPs. It is doing its best within the constraints of the MBS system to support patients, which is where the DVA has the most trouble delivering care.”
Professor Clements said removing the 12-session treatment cycle would reduce paperwork for GPs and for most veteran patients who spend below the threshold.
He said that, while there were always improvements to be made, the program’s details were yet to be finalised and that alarmist comments on social media were “disappointing” and “unfair”.
“The RACGP will be representing its members in discussion with the DVA to ensure this doesn’t leave people disadvantaged,” he told TMR.
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Professor Brad Murphy, a rural generalist and veteran, told TMR hehad been inundated by veterans “beside themselves” with concern about what these allied health changes would mean for them.
“I would say it’s absolutely not DVA’s intention to cause anxiety or limit access to meaningful care… but there’s evidence of some veterans who have claimed $150,000 a year in allied health. That’s just ridiculous,” he said.
While Professor Murphy said the DVA was working “very hard” to resolve this, “trying to hit a moving target is very difficult”.
“DVA are trying to ensure they don’t inconvenience or stop care for veterans, but simultaneously, funding has been a huge blowout,” Dr Murphy said.
While the fee increase is a significant hike – from $75.10 to $110 – dividing 5000 by $110 results in fewer potential individual service accesses, Professor Murphy said.
“It’s absolutely a great thing because it’s about remunerating allied health providers better and encouraging them to engage with veterans, but the downside is that you then get fewer opportunities. That’s less than one visit a week.”
Professor Murphy said it was essential for veterans with more complex needs to remain at home instead of in residential aged care.
“There’s a substantial amount of work needed to improve how we educate veterans to access care and how GPs and their teams provide it,” he said.
“There is a huge amount of anxiety [among the veteran community], and that’s driven mostly by distrust and the fact that there is no information out there about what this is going to look like, and that primarily is because [the DVA] don’t know.”
“GPs are eminently qualified to know what their [veteran] patients’ needs and their individual stories,” he said.
But for GPs who don’t frequently see veterans and are often time-poor, Professor Murphy said the system’s complexity and PBS items could disincentivise them from providing care to veterans.
“I coordinate 500 veterans, but for the average GP who’s just dealing with the myriad of what walks through the door, it’s a huge animal to try to workshop,” he said.
While the DVA recently introduced a $99.30 GP incentive for longer mental health consultations to be claimed up to four times annually, Professor Murphy said there was currently no way to automatically claim the benefit.
“By the time you account for all the manual processing and administration, GPs are essentially undertaking these longer consults for nothing. So there needs to be a better understanding of the business of general practice,” he said.
“We end up seeing veterans are paid less than you would privately bill… It’s going to be a huge disincentive for GPs to engage with veterans, and I think that’s where we’ve got the biggest issue.”
